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News from RSNA 2009
Leading the News
Senate OKs Mammogram Mandate; Preventive Services Chief Says Message Was Distorted
The Senate passed an amendment Dec. 3 to minimize the effect of the new mammography guidelines issued by the U.S. Preventive Services Task Force on pending healthcare reform legislation. The new guidelines suggest cutting back on annual mammograms for women in their 40s with an average risk for the disease. Numerous groups, including the American Cancer Society, say they will follow their own current recommendations to start annual mammogram screenings at age 40 because the breast X-rays have been proven to save lives by detecting tumors early when they are easy to treat. At a House Energy and Commerce subcommittee meeting on health, members of the task force said that their description of the new guidelines may have been "poorly worded" and led people to think they were suggesting that screenings were unnecessary for any patients in their 40s. In order to prevent further confusion, task force chief Dr. Ned Calonge restated the recommendations saying, "Women, age 50 to 74, should have mammography every other year. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient’s values regarding specific benefits and harms."
From "Senate OKs Mammogram Mandate; Preventive Services Chief Says Message Was Distorted"
Diagnostic Imaging (12/04/09)
Most Women in Their 40s Say They Will Ignore New Government Recommendations for Mammograms
The U.S. Preventive Services Task Force (USPSTF) recently announced that most women do not need mammograms until they are 50, but a recent survey shows that over two-thirds of women between age 40 and 49 say they plan to continue to receive annual mammograms. Forty-four percent said they will continue to receive mammograms only if their insurance or someone else pays for them, while 23 percent said they will continue to receive the tests even if they have to pay out-of-pocket. Only 4 percent of respondents said they would not be receiving mammograms in their 40s because of the USPSTF's new recommendations.
From "Most Women in Their 40s Say They Will Ignore New Government Recommendations for Mammograms"
Medical News Today (12/02/09)
CMS Issues Proposed Decision Memo for PET To Identify Bone Metastasis of Cancer
The Centers for Medicare and Medicaid (CMS) have determined that current clinical evidence is not sufficient to support the use of NaF-18 PET for the identification of bone metastasis of cancer. Therefore, CMS has declined to authorize coverage of PET for this use. CMS, however, has proposed that available clinical evidence is sufficient to support the use of NaF-18 PET for the identification of bone metastasis of cancer when the scan is used to inform the initial treatment strategy or guide subsequent treatment after the completion of initial treatment. Based on this conclusion, CMS has agreed to cover NaF-18 PET imaging in the event that the beneficiary treating physician determines that the scan is needed to inform such treatment and when the PET provider is participating in a clinical study designed to collect additional information at the time of the scan to assist in treatment planning and identification of symptomatic bone metastases. The clinical studies for which Medicare will provide coverage must be designed to determine if NaF-18 PET studies lead to a change in the likelihood of appropriate referrals for palliative care, improved quality of life, or improved survival.
From "Proposed Decision Memo for Positron Emission Tomography (NaF-18) to Identify Bone Metastasis of Cancer"
CMS Press Release (11/30/09)
Research
DS CT Coronary Angiography Preserves Image Quality
A study published in the December 2009 issue of Radiology shows that dual-source (DS) spiral CT coronary angiography performed with adaptive electrocardiographic (ECG) pulsing is able to preserve diagnostic image quality and performance independent of heart rate frequency (HRF) or heart rate variability (HRV) at the cost of limited dose reduction in arrhythmic patients. Specifically, the 927-patient study showed that CT coronary angiography yielded good image quality in 98 percent of patients, and no significant differences in image quality were found among HRF and HRV groups. Radiation exposure was significantly higher in patients with low versus high HRF and in patients with severe versus normal HRV. No significant differences among HRF and HRV groups in image quality and diagnostic performance were found.
From "Impact of Heart Rate Frequency and Variability on Radiation Exposure, Image Quality, and Diagnostic Performance in Dual-Source Spiral CT Coronary…"
Radiology (12/01/09) Vol. 253, No. 3, P. 672; Weustink, Annick C.; Neefjes, Lisanne A.; Kyrzopoulos, Stamatis; et al.
CT Scans Predict Survival in Colorectal Cancer
CT imaging analysis of form and structural changes to colorectal liver metastasis after the administration of bevacizumab (Avastin) and chemotherapy may predict overall survival. This conclusion is based on a retrospective study that used CT to analyze a total of 234 colorectal liver metastases from 50 surgical patients, all of whom underwent preoperative chemotherapy that included treatment with bevacizumab. CT scans were conducted before and after the neoadjuvant therapy, and the median follow-up time was 18 months. Radiologists independently analyzed these images for morphologic changes and classified patients into three groups - complete, major, and minor response. They found that optimal morphologic response identified on CT corresponded with survival benefit after hepatic resection.
From "Association of CT Morphologic Criteria With Pathologic Response and Survival in Patients Treated With Bevacizumab for Colorectal Liver Metastases"
Journal of the American Medical Association (12/02/09) Vol. 302, No. 21, P. 2338; Chun, Yun Shin; Vauthey, Jean-Nicolas; Boonsirikamchai, Piyaporn; et al.
Volume CT for Diagnosis of Nodules Found in Lung-Cancer Screening
Researchers have reported that small or slow-growing nodules discovered on a lung scan are unlikely to develop into tumors within two years, a finding that could help physicians determine when more aggressive scans for lung cancer are necessary. The researchers analyzed the cases of 7,557 patients at high risk for lung cancer because they were current or former smokers. All participants received multi-detector CT scans that measured the size of any suspicious-looking nodules. Patients with nodules over 9.7 millimeters in width, or those who had growths of 4.6 millimeters that grew fast enough to more than double in volume every 400 days, were recommended for further testing. Of the 196 patients who fell into that category, 70 were found to have lung cancer and 10 additional cases were found years later. However, of the 7,361 negative CT scans, only 20 cases of lung cancer later developed.
From "Volume CT for Diagnosis of Nodules Found in Lung-Cancer Screening"
New England Journal of Medicine (12/03/09) Mulshine, James L.; Jablons, David M.
News from RSNA 2009
Study Questions Safety of Mammograms for Young Women at High Risk of Cancer
A study presented at the annual meeting of the Radiological Society of North America suggests that the radiation from yearly mammograms may increase the risk of breast cancer in young women already at a high risk for developing cancer, based on genetic mutations or family history. High-risk women are routinely urged to have mammograms earlier in life and more often than women judged to be at average risk, and the American Cancer Society (ACS) and many breast cancer experts say the benefits of screening far outweigh any theoretical risk from radiation. However, the findings of the new study will fuel the debate started by a recent Journal of American Medical Association questioning the value of breast cancer screenings and a report by a government task force suggesting most women could start having mammograms later in life and repeat them less frequently. The new study examined data collected in six previous studies involving about 5,000 high-risk women in the United States and Europe. By examining the medical records of the high-risk women, the researchers found that women who had received mammograms or chest X-rays, which use a lower radiation dose than mammography, were more likely to have breast cancer. The study found high-risk women exposed to radiation before age 20, or women with five or more exposures, were 2.5 times more likely to develop breast cancer than high-risk women who had not been exposed. The analysis only applies to women who have a high risk of breast cancer, which applies to about 0.5 percent to 1 percent of the population. Dr. Marijke C. Jansen-van der Weide, the first author of the study and an epidemiologist at University Medical Center Groningen in the Netherlands, says it is important for high-risk women to weigh the benefits and risks of mammography with their doctors, and to remember that at a young age it is possible to use an alternative screening technique like an MRI. ACS director of cancer screening Dr. Robert Smith questions the analysis' methodology, and he disagrees with the idea that MRI could replace mammography, as MRI misses some tumors that mammography could find, and vice versa. Smith says the best approach for high-risk women is to use the two tests together.
From "Study Questions Safety of Mammograms for Young Women at High Risk of Cancer"
New York Times (12/01/09) Grady, Denise
MRI Shows That Exercise in Middle Age Can Cause Arthritis
High-impact exercise between the ages of 45 and 55 years can cause damage to the knees, according to a recent study presented at RSNA's annual meeting in Chicago. Researchers performed MRI on 236 men and women in that age group, all of whom had not reported previous knee pain. These participants were divided into groups of low, medium, and high exercise based on a standard physical activity questionnaire. The MRI scans showed a relationship between physical activity levels and frequency and severity of knee abnormalities including cartilage and ligament lesions. They also found that certain high-impact, weight-bearing physical activities, such as running and jumping, had the highest correlation with cartilage health problems while low-impact activities, such as swimming and biking, may actually protect diseased cartilage and prevent healthy cartilage from developing disease.
From "Exercise in Middle Age Can Cause Arthritis"
London Telegraph (11/30/09)
Breast Imaging Software Helps Identify Cancers
Researchers have found that elastography, when used in combination with standard ultrasound, was able to correctly identify 98 percent of cancers in women who had an ultrasound to evaluate a suspicious lump in their breast. The newly developed technique was also able to correctly rule out breast cancer in 78 percent of women, Dr. Stamatia Destounis of Elizabeth Wende Breast Care reported at RSNA's annual meeting in Chicago. "The addition of elastography could potentially help decrease the need to perform a biopsy or could reduce the need for additional imaging, thus reducing the anxiety and stress on the patient and also the financial hardship that unnecessary biopsy procedures may cause," Destounis said. Destounis and colleagues tested the elastography software on 193 women between the ages of 18 and 92 years, using it to evaluate a total of 198 lesions.
From "Breast Imaging Software Helps Identify Cancers"
Reuters (11/30/09) Steenhuysen, Julie
Radiologists Reap the Benefits of Advanced Visualization
Advanced visualization technology can be a helpful aid for radiologists, according to research presented at RSNA's annual meeting in Chicago. The presentation focused on the ways advanced visualization allows radiologists to extract more information from scans using cropping, filters, and other techniques. One of the most popular techniques addressed was multiplanar reformatted images, which radiologists can use to view data sets on multiple planes. Other visualization technologies discussed included computer-aided detection (CAD) and maximum intensity projection (MIP).
From "Radiologists Reap the Benefits of Advanced Visualization"
Health Imaging & IT (12/01/09)
RSNA Weekly is a briefing of the latest radiology-related news selected from hundreds of sources by the editors of Information, Inc. While care is taken to use good sources, inaccuracies in source material are not the responsibility of RSNA or Information, Inc.
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